Volume 91  ·   Issue 33  ·  2011

Objective To study the health conditions of pregnant migrant women in some suburban areas of Beijing by comparing a variety of pathological, physiological and social factors and exploring the relevant factors associated with preterm birth so as to prevent effectively preterm birth. Methods A total of 279 cases of pregnancy in preterm birth at out hospital from January 2004 to December 2008 were reviewed.The date of maternal age, parity, prenatal examinations, history of vaginitis, history of chorioamnionitis,premature rupture of membranes, occupation, residing location and education status were recorded. And the relationship between them and preterm birth were analyzed by X2 test. Results The overall incidence of preterm birth was 5.34%. And the following factors had statistically significant differences with premature birth: chorioamnionitis, vaginitis, premature rupture of membranes, a lack of prenatal examinations, low education status, migrant population or maternal parity. However there was no statistical significance ( P ＞0.05) between preterm birth and other factors, such as occupation. Conclusion The incidence of preterm birth is associated with a lack of prenatal examinations, low education status, chorioamnionitis, bacterial vaginitis and premature rupture of membranes. Therefore the migrant women in Beijing should receive targeted education programs during pregnancy. And reproductive tract inflammation should be properly treated.

Objective To investigate the etiology, clinicopathologic features and prognosis of peritoneal malignant mesothelioma (PMM). Methods The diagnostic and therapeutic data for PMM from March 2000 to December 2010 were retrospectively analyzed for 26 women. They had an age range of 41 -78years old. Among them, 21 patients (81%) had a history of exposure to asbestos. Their major symptoms were abdominal distension, abdominal pain, ascites and abdominopelvic mass. Some had cachexia. Intestinal obstruction occurred in all cases during a late stage. Results Among them, the tumor marker of CA125 increased markedly in serum and ascitic samples. The positive rate of ascitic cytology was 31%.Type B ultrasound and CT (computed tomography) examinations showed ascites, peritoneal thickening and abdominopelvic mass and pie-shaped omentum. Their general pathological classifications were as follows:diffuse type (n=23), localized type (n=3), epithelial (n=14) , sarcoma (n=3) and mixed type (n=9). Cytoreductive surgery was performed in 16 cases. Ten patients underwent only laparoscopy while 23patients received chemotherapy. The comparison of life span was not statistically significant between cytoreductive surgery and laparoscopy ( P ＞ 0. 05 ); the difference of life span between ≤ 6 courses of chemotherapy and ＞ 6 courses was not statistically significant ( P ＞ 0. 05 ). Conclusion The history of exposure to asbestos is a risk factor for PMM. PMM with no specific clinical features should be combined with laboratory and imaging studies to make a timely clinical diagnosis. Final diagnosis should be based upon histopathological and immunohistochemical examinations. Surgery and chemotherapy do not prolong the life span of patients. And the patients have a very poor prognosis.

Objective To characterize the safety profiles and serum pharmacokinetic effects of antiepidermal growth factor receptor monoclonal antibody (CMAB009) in advanced cancer patients and evaluate the preliminary evidence of its anti-tumor activity. Methods This phase I, single-center clinical trial had 2 phases of treatment: single-dose phase, followed by a fixed weekly dose. Subjects meeting the inclusion criteria were enrolled. The subjects were randomly assigned to receive 1 of 3 initial doses of CMAB009 (100, 250 & 400 mg/m2) for the purpose of single-dose pharmacokinetic evaluation. After a 28-day washout period of allowing for the characterization of pharmacokinetic end points, the eligible patients were permitted to undergo a successive multi-dose phase study. They were divided into 2 dose groups, group A with 4 weekly doses of 250 mg/m2, group B with the initial dose of 400 mg/m2, followed by 3 weekly doses of 250 mg/m2. The subjects were closely monitored for adverse events throughout the trial. Results A total of 18 subjects were recruited, including colorectal cancer ( n = 10), non-small cell lung cancer ( n =7) and gastric cancer (n = 1 ). CMAB009-associated toxicity was minimal. And the most commonly reported Grade 1/2 adverse events were skin rashes, fever, nausea and headache. Two patients with colorectal cancer achieved partial remission and the time to progression (TTP) was 24 and 16 weeks respectively. Conclusion As a well-tolerated antitumor agent, CMAB009 may be safely administered by the above multi-dosing protocol.

Objective To evaluate the early clinical efficacy of large soft-tissue wounds with intermittent vacuum sealing drainage. Methods From March 2009 to June 2010, the study group was comprised of 56 patients treated with intermittent vacuum sealing drainage. There were 47 males and 9 females with a mean age of 37. 5 years (range: 16 -65 ). Intermittent vacuum sealing drainage was immediately used after an emergency operation. The mean duration of treatment was 2. 5 weeks ( range: 1 -4). The granulation status was observed and wound dressing changed weekly. Results Among them, all wound surfaces were dry and granulation tissues brightly red. There was no deep infection. The mean healing durations of intermittent and continuous vacuum sealing drainage groups were( 32 ± 4. 5 )and( 37 ± 7.5 )days respectively. And there was no statistical difference (P ＞0. 05). Conclusion Intermittent vacuum sealing drainage promotes a rapid and copious production of granulation tissue over soft tissue wound. The patient suffering is minimal and the dressings are easy to manage.

Objective To investigate the acid-base abnormalities of the patients with hyperlactatemia and explore the relationship of hyperlactatemia and metabolic acidosis so as to seek a more precise index of reflecting organ perfusion. Methods From August 2009 to April 2010, all consecutive patients admitted into intensive care unit received an analysis of blood gas. Those individuals with arterial lactate ≥2 mmol/L were selected. Results In the group of hyperlactatemic patients, the occurrence of metabolic acidosis as judged by the traditional method was less than that by the Stewart's method (33.9% vs 56. 0% ). No typical acidemia was found. And all components of metabolic acidosis were calculated. Lactate and SIG (strong ion gap ) contributed a certain percentage to metabolic acidosis in the survivor and nonsurvivor groups [(33.6±17.9)% vs (28.6 ±23.5)%, (42.1 ±18.5)% vs (44.9 ±23.0)%].Conclusion Among the hyperlactatemic patients (Lac ≥ 2 ), lactate and unmeasured anions account for most instances of acidosis. These two indicators may offer a more accurate reflection of tissue perfusion.

Objective To observe the effects of intraoperative application of radical scavenger edaravone in severe elderly cases. Methods A total of 400 severe elderly patients scheduled for surgery were randomly assigned to receive edaravone 60 mg/40 ml ( Group Y) or an equal volume of normal saline (Group C). The arterial blood samples were harvested at immediately after pricking, 1 hour after the beginning of surgery and before saturation to determine the levels of superoxide dismutase (SOD) and malondialdehyde (MDA). The operative duration, fluid volume, blood loss, blood transfusion volume,urine output, intraoperative adverse events, mortality rate, total hospital stay, intensive care unit (ICU)stay, postoperative mechanical ventilation time and complications were recorded. Patients undergoing offpump coronary artery bypass graft (OPCABG) were evaluated for troponin Ⅰ (cTn Ⅰ ) and left ventricular ejection fraction (LVEF) before and after 24 hours of surgery. Results SOD was higher and MDA lower in Group Y than those in Group C at 1 hour intraoperation and before saturation[SOD: (87 ± 14)U/ml vs(78 ±14)U/ml, (83±13)U/mlvs(77±14)U/ml, P＜0.01, ＜0.05; MDA : (11 ±5)nmol/Lvs(14±7)nmol/L,( 11 ± 5 ) nmol/L vs ( 14 ± 6) nmol/L, P ＜ 0. 05, ＜ 0. 01]. There were more intraoperative hypotension cases requiring a continuous application of vasoactive drugs in Group C(37 cases vs 19 cases),total hospital stay[(21 ±9 )d vs (23±g)d, P＜0.05] and ICU stay[(10±7)dvs (13±9)d, P＜0. 05] were also longer. Postoperative cTn Ⅰ and LVEF of Group Y significantly improved in OPCABG cases ( all P ＜ 0. 05 ). Conclusion The intraoperative application of edaravone in severe elderly patients may prevent MDA increase and SOD decrease and reduce free radical damage. Especially in OPCABG patients,cTn Ⅰ and LVEF improve significantly.

Objective To explore the expression of ATP (adenosine triphosphate)-binding gene mRNA ( messenger ribonucleic acid) in brain tissues of patients with drug-resistant epilepsy and understand their biological characteristics. Methods The postoperative brain tissues were collected randomly from 40patients with drug-refractory epilepsy. Based on the expected results of complementary DNA (cDNA) microarray, reverse transcription-polymerase chain reaction (RT-PCR) was used to evaluate ATP-binding gene mRNA expression in brain tissues of 40 patients with drug-resistant epilepsy and 8 normal controls.Results As compared with 8 normal control cases, the candidate genes of ATP-binding mRNA were higherly expressed in the brain tissues of patients with drug-resistant epilepsy. The rates of Cy5/Cy3 were CDC2L5 2. 159, ROCK1 2. 538, STCH 2. 106, OXSR1 3. 791 and ABCB6 2. 583 respectively. And the results of RT-PCR corresponded with those of cDNA chip. Conclusion The significant neuronal upregulation of ATP-binding gene mRNA suggests that abnormal energy metabolism exist in brain tissues of patients with drug-resistant epilepsy. And the apoptosis of neurons and synaptic plasticity caused by abnormal energy metabolism may play an important role in the occurrence and development of patients with drug-resistant epilepsy.

Objective To evaluate the feasibility, safety and efficiency of a new biliary intraluminal irradiation stent system loaded with 125I seeds. Methods The study was approved by the institutional ethics committee of our hospital, and informed consent was obtained from each patient. Patients with malignant biliary obstruction were treated with a new biliary irradiation stent system loaded with 125I seeds according to a treatment plan system. All of the biliary seeds carrying devices combined with the matched biliary stents were placed by the procedures of percutaneous transhepatic biliary puncture. After stents implantation, all patients were followed-up. Results The whole biliary stent systems loaded with 125I seeds were successfully placed in 12 patients, no 125I seeds exfoliation during the procedure and no radioactive leakage by general emission computed tomography reexamination during the follow-up were observed. The obstructive jaundice relived and the systemic conditions improved remarkably in all patients. There were no complications related to the stents, such as biliary perforation or hemobilia, were observed. And no significant change in the blood routine and immune paraneters detected before and after operation during the follow-up were observed. The median survival period was 7.40 months (95% CI 6. 204-8. 596) and the mean survival period was 8. 03 months (95% CI 6. 142 - 9. 909). Conclusion Development of a new biliary intraluminal irradiation stent system loaded with 125I seeds is technically feasible and safe, treatment of this stent system has potential benefits of extending survival, however the long-term clinical efficacy needs to be certificated by further follow-up observation and control trials.

.Objective To investigate the expression of 14-3-3ε in esophageal squamous cell carcinoma (ESCC) and relationship of 14-3-3ε and clinicopathological factors of ECSS patients. Methods The 14-3-3ε expression in tumors and adjacent normal epithelia from 72 ESCC patients was detected by immunohistochemical staining. Correlations of 14-3-3ε expression or their subcellular localization and clinicopathological factors were analyzed using Chi-squared test. Survival curves were generated according to the Kaplan-Meier method, and the statistical analysis was performed by Log-rank test. Results The expression of 14-3-3ε protein was significantly up-regulated in tumors with 77. 8% positive and 27. 8%strong positive staining, compared with paired adjacent normal epithelia with 43. 1% positive and only 2. 8%strong positive staining (P ＜ 0. 01 ). In a total of 56 positive staining tumors, 14-3-3ε was detected in cytoplasm of 37 (66. 1% ), in nucleus of 4 (7. 1% ) ,in both cytoplasm and nucleus of 15 (26. 8% ) cases.Whereas, in a total of 31 positive staining normal epithelia, 14-3-3ε was detected in cytoplasm of 0, in nucleus of 13 (41.9%), in both cytoplasm and nucleus of 18 ( 58. 1% ) cases ( P ＜ 0. 01 ). Statistical analysis revealed that strong 14-3-3ε expression was correlated with lymph node metastasis (P = 0. 028) and lower 5-year survival (P = 0. 018). The survival curves calculated by Kaplan-Meier method further showed that the patients with strong 14-3-3ε expression had a shorter survival than patients with negative or weak 14-3-3ε expression (Log-rank,P =0. 031 ). No correlation was found between subcellular localization of 14-3-3ε in tumor cells and clinicopathologic factors and prognosis of ESCC patients. Conclusion The 14-3-3εexpression is significantly up-regulated in ESCCs. It was usually located in cytoplasm of tumor cells, but nucleus of normal epithelia. Strong expression of 14-3-3ε in tumors is associated with lymph node metastasis and considered as an poor prognostic factor for ESCC.

Objective To explore the effects of exogenous transforming growth factor-β3 (TGF-β3)on the activities of its promoter and cAMP-responsive element binding protein-1 ( CREB-1 ) in rat hepatic stellate cell (HSC-T6). Methods HSC-T6 was cultured and treated with or without exogenous TGF-β3( 10 μg/L). Then cell extracts, total RNA and nuclear proteins were collected at different time points. The specimens were detected by luciferase reporter assay, Western blotting and real-time RT-PCR (reverse transcription-polymerase chain reaction) respectively. Results After treatment, the activity of TGF-β3promoter peaked at 24 h ( 10. 68 ±0. 57 vs 4. 83 ±0. 56, 2. 2 folds vs control). And the mutational CRE site completely blocked the activity of TGF-β3 promoter(0. 73 ±0. 03, P ＜0. 05 ). In addition, exogenous TGFβ3 increased the expression of phospho-CREB-1 in a time-dependent manner. It peaked at 1 h (2. 0 folds vs control) and declined slowly. And exogenous TGF-β3 had no effect on the mRNA and protein expressions of CREB-1 ( P ＞ 0. 05 ). Conclusion The activity of TGF-β3 promoter is up-regulated by exogenous TGF-β3.And CRE site in TGF-β3 promoter region is important for the transcription of TGF-β3 gene in HSC-T6.While activating CREB-1, exogenous TGF-β3 has no effect on the expressions of CREB-1 protein and mRNA.

Objective To explore the effects and relationship of specific demethylation agent 5-Aza-2'-deoxycytidine (5-Aza-CdR) on colorectal cancer ( CRC ) induced by 1,2-dimethylhydrazine ( DMH ) in mouse and the in vivo expression of cyclin-dependent kinases inhibitor p16/CDKN, mRNA. Methods A total of 40 male KM mice were randomized into 2 groups and CRC was induced by a 22-week injection of DMH. One group was interfered by specific DNA methyltransferase inhibitor 5-Aza-CdR. Another 10 the same source male KM mice were induced by a 22-week injection of saline as none induced cancer control group (negative control group ). All mice were sacrificed to examine for colorectal neoplasm.Immunohistochemical staining was used to assess the expression of proliferating cell nuclear antigen (PCNA). The expression of p16/CDKN2 mRNA was detected by in situ hybridization. Results The average numbers of neoplasm was higher in the DMH group (7. 6 ±3. 1 ) than that of the group DMH +5-Aza-CdR (3.4 ± 1.8, P ＜0. 05). Immunohistochemical staining showed there was a significant elevation of PCNA in the group DMH(16/19) as compared with that in the group DMH +5-Aza-CdR ( 11/19, P ＜0. 05 ). In situ hybridization revealed that the level of tumor suppressor gene p16/CDKN2 mRNA was significantly lower in the group DMH than that in the group DMH +5-Aza-CdR. Conclusion The specific demethylation agent 5-Aza-2'-deoxycytidine may inhibit the carcinogenesis of CRC. Its mechanism may be related with a high expression of p16/CDKN2 mRNA.

Objective To establish the cerebral hyper-perfusion model after chronic forebrain ischemia in rats. Methods A total of 72 male rats were equally randomized into 2 modeling groups. The ligation of bilateral common carotid artery could induce chronic forebrain ischemia. And 36 rats were randomly grouped by ischemia duration: control group ( n = 9 ), sham group ( n = 9 ), 2-wcek ischemia group ( n = 9 ) and 4-wcek ischemia group ( n = 9 ). The blood flow in frontal lobe was measured at pre- and post-ligation. The neurological score and cerebral infarction area were also compared among the groups. The min-1 via tail vein to produce cerebrally hyperperfused blood flow rate over 200% of baseline following chronic ischemia. According to cerebral hyper-perfusion duration, 36 rats were randomly assigned into 4 groups: control group ( n = 9 ), saline infusion group ( n = 9 ), 30-minute cerebral hyper-perfusion group ( n = 9) and 2-hour cerebral hyper-perfusion group ( n = 9). The blood flow in frontal lobe was measured before and after cerebral hyper-perfusion. The neurological score, blood-brain barrier permeability and drywet weight ratio of brain also were compared among the groups. Results The forebrain blood flow decreased by 67% ± 2% after the ligation of bilateral common carotid artery. There was significant difference between cerebral hyper-perfusion and saline infusion groups ( P ＜ 0. 01 ). No statistic difference was observed in neurological score and cerebral infarction area between 2-week ischemia and control groups. But it was obvious between 4-week ischemia and control groups. The permeability in blood-brain barrier of rats significantly increased in 2-hour hyper-perfusion group ( P ＜ 0.05 ). Conclusion The 2-hour duration of cerebral hyper-perfusion following a 2-week ligation of bilateral common carotid artery may establish a reliable cerebral hyper-perfusion model in rats.

Objective To explore the effects of different doses of transplanted microglia (MG) on ββ-amyloid protein (Aβ) in rat brain model of Alzheimer's disease (AD). Methods A total of 60 SD rats were randomly divided into experimental group and control group. The experimental group was injected with Aβ-42 and the control group saline in hippocampus. At Day 3, different doses of continuously expressed enhanced green fluorescent protein (EGFP) microglial cells cuhured in vitro were injected into the rats via carotid artery. At Day 3 post-injection, Aβ was labeled by immunofluorescent method. And the expressions of EGFP microglia and Aβ were detected in hippocampus by fluorescence. The relative brain expression of β-amyloid precursor protein (APP) mRNA was analyzed by RT-PCR (reverse transcription-polymerase chain reaction ). Results The mean fluorescent intensity of EGFP was significantly higher in each experimental group (5.62 ±0.61, 8.85 ±0.33, 10.24 ±0.45, 11.26 ±0.37, 12.75 ±0.65) than the control group ( 2. 22 ± 0. 32, all P ＜ 0.05 ); Fluorescent immunohistochemistry showed that the mean fluorescent intensity of Aβ in the 4 × 106 dose group (9.53 ± 0. 23 ) and the 12 × 106 dose group (8.32 ±0. 46) were significantly higher than that in the 8 × 106 dose group (4.56 ±0. 13, both P ＜0.05) ; The fluorescent regions had partial consistence of EGFP and Aβ; RT-PCR (reverse transcription-polymerase chain reaction) results showed that the relative expressions of APP mRNA in the 4 × 106 dose group ( 1.83 ±0.22) and the 12 × 106 dose group ( 1.94 ±0.28) were significantly higher than that in the 8 × 106 dose group (0.43 ± 0.12, both P ＜ 0.05 ). Conclusion Aβ has the chemotactic role of MG. MG may swallow Aβ protein partially. But a high dose of MG also accelerates the formation of Aβ.

Objective To investigate the effects of the transplantation of adipose-derived stem cells (ADSC) on the expression of Notch1-Dll4signaling pathway in brains of rats with focal cerebral ischemia.Methods Sixty-five male adult Sprague-Dawley rats were randomly divided into 4 groups: sham-operated group, MCAO (occlusion of middle cerebral artery) group, A DSC-treated group and ADSC & DAPT-treated group. A permanent model of focal cerebral ischemia was established by modified Zea-Longa's method. At 24 hours post-MCAO, 1 × 106 DAPT-labeled ADSC were injected into the lateral ventricle of rats in the ADSC-treated group and the same dose of ADSC with DAPT (γ secretase inhibitor, N-[N-( 3, 5-difluorophenacetyl)-L-alanyl]-S-phenylglycine t-butyl ester) to the rats in the ADSC & DAPT -treated group. Rats are sacrificed at 4, 7, 14 and 28 d post-MCAO. The amount of microvessels was quantified.And the levels of Notch1, Dll4 and Hes1 were detected by Western blot and immunohistochemistry. Results The density of microvessels significantly increased in the ADSC group ( 13.93 ±0. 50, 17.90 ±0. 62, 20. 78±0.80, 17.28±1.65) versus the MCAO group (7.03 ±0.22, 10.83 ±0.63, 16.35 ±0.54, 13.80 ± 2.38) (P＜0.05)and the ADSC +DAPT group (5.73 ±0.30, 7.58 ±0.52, 7.65 ±0.45, 6.48 ±1.47)(P＜0.05). And compared with the MCAO group (1.29 ±0.07, 2. 13 ±0.21, 1.92 ±0.03) and the ADSC + DAPT group ( 1. 162 ± 0. 099, 1. 684 ± 0. 180, 1. 041 ± 0. 040), the expressions of Notch1, D114 and Hesl proteins were significantly up-regulated at 14d in the ADSC group (2. 52 ± 0. 22, 4. 52 ± 0. 36,2. 62 ± 0. 05 ) ( P ＜ 0. 05 ). Conclusion The transplantation of ADSC can improve angiogenesis by upregulating the post-MCAO expression of Notch1-Dll4 signaling pathway in rats.

Objective To investigate the interactions of fatty acid oxidation with oxidative stress on the preeclampsia ( PE )-like development by establishing murine models at multiple stages of gestation. Methods Wild-type (WT) mice were injected subcutaneously with nitric oxide synthase (NOS) inhibitor L-arginine methyl ester (L-NAME, 50 mg· kg-1 · d-1) to establish PE-like model (L-NAME group) at early, middle and late pregnant periods respectively. Normal saline (NS group) was injected simultaneously as a control. All groups were divided into subgroups, standard chow group (SC) and high-fat diet group (HF). From Day 1 of pregnancy, all groups were fed simultaneously. ApoE-/- pregnant mice were selected as a control group. Identification of mice model and the expressions of mRNA and protein of LCHAD,p47phox, p38MAPK and COX-2 were confirmed by RT-PCR (reverse transcription-polymerase chain reaction) and Western blot respectively. Data were analyzed statistically. Results The expressions of mRNA and protein of LCHAD significantly decreased in early and middle L-NAME groups in both apoE-/- and WT mice(P＜0. 05). The expressions of mRNA and protein of LCHAD in the HF groups were lower than the SC groups. The changes were marked in the early HF + L-NAME subgroup in apoE-/- mice(P ＜0. 05). As compared with other groups, the placental expressions of mRNA and protein of p47phox and COX-2 markedly increased in the early and middle L-NAME subgroups in apoE-/- mice ( P ＜ 0. 05 ),especially in early and middle HF + L-NAME subgroups in apoE-/- mice ( P ＜ 0. 05 ). ApoE-/- mice had a higher expression than that of WT groups (P ＜0. 05). The expressions of mRNA and protein of p38MAPK showed no differences among all groups. Correlation analysis showed a negative correlation between gene and protein expressions of LCHAD and p47phox, COX-2 ( P ＜ 0. 05 ) . There was significantly positively correlated between the expression of p47phox, COX-2 and protein (P ＜0. 05). Conclusions The PE-like symptoms have fatty acid oxidation dysfunctions. There is a lower expression of LCHAD. The earlier its onset, the more obvious dysfunctions. In early and middle L-NAME groups, oxidative stress and inflammatory injury occur in both apoE-/- and WT mice. A high-fat diet may aggravate the level of oxidative stress especially in PE-like apoE-/- murine model.

Polycystic ovary syndrome (PCOS) is the most common complicated endocrine and metabolic disease in women of childbearing age, which starts in adolescence and has a prevalence of 5% ~10% in women of childbearing age; The main characteristics are long-term anovulation (ovulatory dysfunction), excessive androgen and polycystic ovarian changes.

A 56-year-old female was admitted to hospital at 23:00 on October 31, 2009 due to overdose of Nux vomica caused by convulsions and confusion for 16 h. The patient had a history of rheumatoid arthritis for 3 years, deformity of the joints of hands and feet, and limited movement at ordinary times. He denied a history of cold, diarrhea and vaccination before the onset of the disease, and denied a history of epileptic seizures and hypertension.